| NPI | 1093020489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA DEVERICH Therapist 757-903-2406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0717001251) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2016-09-21 |